The court disagreed. "Because wanton or reckless behavior is an essential element of the offense of involuntary manslaughter, the evidence is insufficient to support a conviction unless there is at least one individual whose behavior could permissibly be found to have been wanton or reckless," the court wrote.

The efforts of the state's attorney general were particularly important because the regulatory framework alone cannot adequately protect nursing home residents. In 2007, 94 percent of for-profit nursing homes, 91 percent of government-run homes, and 88 percent of nonprofit homes were cited for deficiencies, according to the Office of the Inspector General of the U.S. Department of Health and Human Services — and yet much malfeasance often goes unpunished. The Government Accountability Office found in 2007 that almost half the homes it reviewed cycled "in and out of compliance, continuing to harm residents."

Criminal convictions are important tools because once criminally convicted, a corporation can be excluded from participation in government health programs. The potential withdrawal of eligibility for Medicaid, Medicare or other programs can prove to be a tremendous financial disincentive for nursing homes and can help spur compliance with the law.

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